Guidelines for INFECTION CONTROL POLICY - Safdarjung Hospital

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Epidemiological methodsThe investigation of an outbreak may require expert epidemiological advice on procedures.Formulation of a hypothesis regarding source and spread is made before undertaking microbiologicalinvestigations in order that the most appropriate specimens are collected.Steps to be taken to investigate an outbreakStep 1• Recognition of the outbreak. Is there an increase in the number of cases of a particularinfection or a rise in prevalence of an organism? Such findings indicate a possible outbreak.• Preliminary investigation must begin by developing a case definition, identifying the site,pathogen and affected population. Define the outbreak in time, person and place.• Determination of the magnitude of the problem and if immediate control measures arerequired. If so general control measures such as isolation or cohorting of infected cases;strict hand washing and asepsis should be immediately applied.• Verification of the diagnosis. Each case should be reviewed to meet the definition.• Confirmation that an outbreak exists by comparing the present rate of occurrence withthe endemic rate should be made.Step 2• The appropriate departments, personnel and the hospital administration should be notifiedand involved.Step 3• Additional cases must be searched for by examining the clinical and microbiological ecords.• Line listing for every case, patient details, place and time of occurrence and infectiondetails should be developed.• An epidemic curve based on place and time of occurrence should be developed, the dateanalyzed, the common features of the cases e.g. age, sex, exposure to various riskfactors, underlying diseases etc. should be identified.• A hypothesis based on literature search and the features common to the cases; shouldbe formulated about suspected causes of the outbreak.• Microbiological investigations depending upon the suspected epidemiology of the causativeorganism should be carried out. This will include (a) microbial culture of cases, carriersand environments (b) epidemiological typing of the isolates to identify clonal relatedness.• The hypothesis should be tested by reviewing additional cases in a case control study,cohort study, and microbiological study.Step 4• Specific control measures should be implemented as soon as the cause of outbreak isidentified.• Monitoring for further cases and effectiveness of control measures should be done.• A report should be prepared for presentation to the HICC, departments involved in theoutbreak and administration.Immediate control measuresControl measures should be initiated during the process of investigation. An intensive reviewof infection control measures should be made and general control measures initiated at once.General measures include:• Strict hand washing• Intensification of environmental cleaning and hygiene• Adherence to aseptic protocols• Strengthening of disinfection and sterilization14
Microbiological StudyMicrobiological study is planned depending upon the known epidemiology of the infectionproblem. The study is carried out to identify possible sources and routes of transmission.The investigation may include cultures from other body sites of the patient, other patients, staffand environment. Careful selection of specimens to be cultured is essential to obtain meaningfuldata.Specific control measuresSpecific control measures are instituted on the basis of nature of agent and characteristics ofthe high-risk group and the possible sources. These measures may include :• Identification and elimination of the contaminated product• Modification of nursing procedures• Identification and treatment of carriers• Rectification of lapse in clinical technique or procedureEvaluation of efficacy of control measures• The efficacy of control measures should be evaluated by a continued follow-up of casesafter the outbreak, clinically as well as microbiologically. Control measures are effectiveif cases cease to occur or return to the endemic level.The outbreak will be documented and the records should be kept with HICC and should bepresented in HICC meeting.ANTIMICROBIAL POLICYThe annual antibiogram is released from the microbiology department. Antibiotic susceptibilitytests is analyzed regularly on a quarterly basis and the common resistance patterns of thebacterial isolates are reported and discussed in the HICC meetings and the antibiotic policy isreviewed accordingly. Present Antibiotic policy is published as separate documentAntibiotic policy is prepared in consultation with respective clinical departmentsAntibiotic policy shall be prepared using following general principles:1. Data is analyzed on a quarterly basis as per hospital records)(a) Common etiological agents as per(i) site of infection(ii) age groups(iii) patient location – outdoor (OPD), indoor (wards & critical care areas)(b) Antibiogram data as per(i) site of infection(ii) age groups(iii) patient location – outdoor (OPD), indoor (wards & critical care areas)(c) Unusually resistant organisms to be confirmed and submitted for further characterizationto National Centre for Disease Control (NCDC) for2. Standard treatment guidelines [categorization of patients as per age and Communityacquired infections (CAI) / Health care associated infections (HCAI)](a) Guidelines for empirical antimicrobial therapy as per common clinical syndrome(i) Adults & older children1. Blood Stream Infections (BSI)2. Meningitis3. UTI15
Page 2 and 3: CONTRIBUTORSCreated by : Dr. Rajni
Page 5 and 6: HOSPITAL INFECTION CONTROL TEAM (HI
Page 7 and 8: 12. Training and education of HCW C
Page 9 and 10: Schedule may be changed to increase
Page 11 and 12: Semi-critical instruments /equipmen
Page 13: • The isolation of the patient wo
Page 17 and 18: Annexure-1Policy on‘Hospital Wast
Page 19 and 20: CONTENTSTOPIC SUB-TOPIC PAGE NO.1.
Page 21 and 22: HOSPITAL WASTE MANAGEMENT COMMITTEE
Page 23 and 24: Color-coded bags & Category wise Tr
Page 25 and 26: MAINTENANCE OF EQUIPMENTMaintenance
Page 27 and 28: • Labelled as with ‘Cytotoxic
Page 29 and 30: MERCURY SPILL MANAGEMENT :If accide
Page 31 and 32: FUTURE PROPOSAL FOR DISPOSAL OF RAD
Page 33 and 34: Minimization (ofwaste)MonitoringOn-
Page 35 and 36: PERFORMA OF BIOMEDICAL WASTE MANAGE
Page 37 and 38: ANNEXURE-2PROTOCOL FOR MANAGEMENT O
Page 39 and 40: ANNEXURE-IIRECOMMENDED POSTEXPOSURE
Page 41: Step-II : Determine the HIV STATUS

Guidelines for INFECTION CONTROL POLICY - Safdarjung Hospital

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